Reactive Attachment Disorder (RAD)

Knowledge is the Key to

Understanding Jo-El E. Thompson, Ph.D.

Heritage Centers

Learning Objectives

Understand a working definition of attachment

Distinguish between two subtypes of Reactive Attachment Disorder (RAD)

Recognize four common symptoms of RAD

Identify three possible strategies staff can implement in the IRA to assist the individual with RAD

What is Reactive Attachment Disorder?

RAD is a complex psychiatric disorder in which

individuals have difficulty forming lasting, loving and

intimate relationships.

Markedly disturbed and developmentally inappropriate

social relatedness in most contexts that begins before the

age of five and is associated with grossly pathological care. (DSM-IV-TR, 2000)

Glossary

Psychiatric disorder - occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture

(http://en.wikipedia.org, 2007)

Markedly disturbed - showing extreme symptoms of emotional illness or mental disorder

(http://medical.merriam-webster.com, 2007)

Social relatedness - a person’s ability to associate and interact with society and its members (e.g. A child with RAD does not possess appropriate social relatedness as seen in excessive familiarity with strangers.) (http://en.wikipedia.org, 2007)

Grossly Pathological Care:

Grossly pathological care is defined by:

a. A persistent disregard for the individuals emotional

needs for comfort, stimulation, and affection

b. Persistent disregard for the individuals physical needs

c. Repeated changes of primary caregivers (Schwartz & Davis, 2006)

Medical Conditions Associated with Grossly

Pathological Care and RAD:

Include: malnutrition, growth delay, evidence

of physical abuse, vitamin deficiencies, or

infectious diseases.

(DSM-IV-TR, 2000)

Two Subtypes of RAD

Inhibited - Refers to individuals who continually fail to

initiate and respond to social interactions in a

developmentally appropriate way

-Interactions are often met with a variety of

approaches, avoidance and resisting to com-

forting, often hypervigilant or highly

ambivalent

Example: A individual that does not seek comfort

from a parent or caregiver during times of threat,

alarm or distress.

Two Subtypes of RAD

Disinhibited - Refers to a individual who has an

inability to display appropriate

selective attachments (DSM-IV-TR, 2000)

- More enduring over time than the

inhibited type

Example: A individual who displays excessive familiarity

with strangers.

Why is Attachment important?

Attachment is essential for the formation of a healthy personality which includes:

Development of a conscience

Ability to become self-reliant

Ability to think logically

Ability to cope with frustration and stress

Ability to handle fear or a threat to self

Development of relationships

Symptoms displayed by individuals with RAD

Lack of self-control / impulsive

Speech and language delays

Lack of conscience / shows no remorse

Indiscriminately affectionate with strangers

Avoids physical contact

Hyperactive

Symptoms of RAD, Cont’d

Aggressive

Destructive towards self, property and others

Food issues: hordes, gorges, refuses to eat,

hides food

Often on guard, anxious, wary

Prefers to play alone

Inhibition or hesitancy in social interactions

Potential Causes of RAD

Frequent changes in primary caregiver

Extended separation from the parent/primary caregiver

Frequent moves and/or placements in foster care or institutions

Traumatic experiences

Undiagnosed, painful illness such as cholic, ear infections, etc.

Young or inexperienced mother with poor parenting skills

Neglect

Abuse

Prevalence

The prevalence of RAD has been estimated at 1%

of all children under the age of five. Children

orphaned at a young age have an increased

likelihood of this disorder. However, since the

onset can be detected as early as two months of

age, considerable improvement or remission is

possible if the child experiences an appropriately

supportive environment. (DSM-IV-TR, 2000)

Effective Treatments

Family therapy - helps the parents or caregivers

and other children in the family understand

symptoms of the disorder and effective

interventions.

Individual therapy - helps the individual directly with

monitoring emotions and behavior

Play therapy - helps the individual learn appropriate

skills for interacting with peers and other

social situations

Other possible treatment options

Medication - for symptoms of the disorder (for

example, anxiety and hyperactivity)

BSP - specifically designed behavioral program

that can help the individual learn skills

required for work and social success,

while addressing behavioral and emotional

difficulties.

What can I do as a Staff ?

Get information on attachment and helping your individual form a healthy bonds. (references that follow include helpful websites)

If you don’t have much experience in caring for an individual with RAD, take classes or try to volunteer with children with RAD to increase your knowledge and empathy.

Be active with your individual through making eye contact, talking with, smiling at, sharing mealtimes.

IRA Implications

Individuals with reactive attachment disorder have

difficulties self-regulating emotions and behaviors.

These individuals struggle to form typical,

reciprocal relationships with peers and adults.

Self-regulatory and social skills are important

prerequisites for work readiness and social

success.

How can Staff help a Individual with RAD reach Social and Work Success?

Be consistent, predictable, and repetitive

Set clear, concise expectations

Set a routine

Model and teach appropriate social behaviors

Maintain realistic expectations

Ignore “junk” behaviors - that is behaviors that are not

harmful to the individual, others or property

√ FOLLOW THE BSP!

More Techniques for Staff

Be patient with the individual (and yourself)

Understand behaviors before acting

Utilize other resources (Psychologist, Behavior Support Specialist, Internet) to gain needed information to understand the effects of Reactive Attachment disorder on the individuals behavior and emotions

Help the individual learn how to regulate his or her feelings and actions

References

American academy of child and adolescent psychiatry. (2007).

http://www.aacap.org/page.ww?name=Reactive+Attachment+Disorder&section=F

acts+ for+Family. American Psychiatric Association. (2000). Diagnostic and statistical manual of

mental disorders (4th ed.) Text revision. Washington, DC: Author.

Association for treatment and training in the attachment of children. (2007). http://www.attach.org.

Attachment & trauma network: hope & healing for traumatized children and their families. (2006). http://www.attachmenttraumanetwork.org

Attachment disorder site. (2007). http://www.attachmentdisorder.net.

References cont’d Helpguide: a trusted non-profit resource. (2001-2007).

http://www.helpguide.org/mental/parenting_bonding_reactive_attachment_disord

Merriam-Webster. (2007). http://medical.merriam-webster.com

Reactive attachment disorder and detachment issues. (2007).

http://www.radkid.org

Schwartz, E., and Davis, A. (2006). Reactive Attachment disorder: Implications for school readiness and school functioning. Psychology in Schools, 43, 471-479.

Stoller, J.L. (2006). Parenting other people’s children: understanding and repairing reactive attachment disorder. Vintage Press.

Thomas, N. L. (2005). When love is not enough: a guide to parenting children with RAD. Colorado: Families by Design.

Wikipedia. (2007). http://en.wikipedia.org